Congenital coronary artery fistulas in adults: surgical treatment and outcome

Abstract

Background: Congenital coronary artery fistulas, a subgroup of anomalies of the coronary arteries, are an extremly rare cardiac defect. Most patients are asymptomatic, and if symptoms are presented, they depend on the underlying anatomy. Knowledge of those fistulas is important for prognosis and management. Methods: Thirteen adult patients with congenital coronary fistulas (8 male, 5 female) were operated in our department during the last decade (1990–1999). Mean age was 61.5±10.8 years. Diagnosis was made by coronary angiography, and 15 congenital coronary artery fistulas were found. Results: All patients were symptomatic with clinical symptoms depending on the associated cardiac disorder. Coronary artery fistulas originated from the proximal left descending artery ( n=10), left main stem ( n=3), circumflex artery ( n=1), right coronary artery ( n=1), and drained into the main pulmonary artery ( n=14) and left ventricle ( n=1). Nine fistulas (60%) were interrupted on the outside of the heart, and six fistulas (40%) were closed through the opened pulmonary artery. There was no surgical death and no fistula-related complication. Conclusions: Surgical closure of congenital coronary artery fistulas in adults can be performed with a very low risk, and closure is recommended to prevent complications.